Lack of weight gain during the first two months of treatment and HIV independently predict unsuccessful treatment outcomes in tuberculosis

Vanderbilt University School of Medicine. Department of Medicine. Division of Epidemiology. Nashville, Tennessee, USA.
Vanderbilt University School of Medicine. Department of Medicine. Division of Epidemiology. Nashville, Tennessee, USA / Vanderbilt University School of Medicine. Division of Infectious Diseases, Department of Medicine. Nashville, Tennessee, USA.
Fundação Medicina Tropical Dr Heitor Vieira Dourado. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Manaus, AM, Brasil.
Universidade do Estado do Amazonas. Manaus, AM, Brasil / Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Rio de Janeiro, RJ, Brasil.
Vanderbilt University School of Medicine. Department of Medicine. Division of Infectious Diseases. Nashville, Tennessee, USA / Fundação José Silveira. Instituto Brasileiro para Investigação da Tuberculose. Multinational Organization Network Sponsoring Translational and Epidemiological Research. Salvador, BA, Brazil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Salvador. Laureate Universities. Salvador, BA, Brasil / Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil / Faculdade de Tecnologia e Ciências. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Secretaria Municipal de Saúde do Rio de Janeiro. Clínica da Família Rinaldo Delamare. Rocinha, RJ, Brasil.
Fundação José Silveira. Instituto Brasileiro para Investigação da Tuberculose. Multinational Organization Network Sponsoring Translational and Epidemiological Research. Salvador, BA, Brazil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Vanderbilt University School of Medicine. Division of Infectious Diseases, Department of Medicine. Nashville, Tennessee, USA.
Vanderbilt University School of Medicine. Division of Infectious Diseases, Department of Medicine. Nashville, Tennessee, USA.
Secretaria Municipal de Saúde do Rio de Janeiro. Clínica da Família Rinaldo Delamare. Rocinha, RJ, Brasil.
Vanderbilt University School of Medicine. Division of Infectious Diseases, Department of Medicine. Nashville, Tennessee, USA.

Abstract

Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV). Methods. We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression. Results. Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], −2.8 to .1) less than HIVnegative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1–10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%–.95%) per 1-kg increase. Conclusions. PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.

Keywords in Portuguese

Tuberculose
HIV
Mudanças de peso corporal
Resultado do tratamento;
Estudo de observação

Keywords

Tuberculosis
HIV
Body weight changes
Treatment outcome
Observational study

Publisher

Oxfor University Press

Citation

PEETLUK, Lauren S. et al. Lack of weight gain during the first two months of treatment and HIV independently predict unsuccessful treatment outcomes in tuberculosis. Journal of Infectious Diseases, p. 1-9, 2019.

DOI

10.1093/infdis/jiz595

ISSN

0022-1899

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/37977

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